Oral cancer drugs: group pushes for universal coverage

CBC

People in Ontario and Atlantic Canada face financial hardship that other Canadians don't when it comes to accessing cancer treatments taken orally, a coalition of more than 30 cancer organizations says.

The group CanCertainty, led by Kidney Care Canada, launched a campaign Monday calling for "equal and fair" cancer treatment for all Canadians, no matter what type of medication they're on.

Under the Canada Health Act, intravenous cancer treatments are universally covered because they are administered in a hospital or medical setting. But that's not always the case when medications are taken orally.

CanCertainty released a white paper by the Cameron Institute, a public policy think-tank, detailing a patchwork of coverage and what it calls discriminatory practices across the country. The paper argues universal coverage makes financial sense to hospital budgets as well as patients, who can end up in debt after a cancer diagnosis.

The institute's paper notes that only some provinces provide funding:

- Canadians living in British Columbia, Alberta, Saskatchewan or Manitoba have their cancer drugs paid by the provincial government regardless of their age, income level or whether they are intravenously or orally administered.

- Although the funding mechanisms are different, Canadians in Quebec also have both intravenous and oral cancer drugs reimbursed regardless of age or income level.

- Oral, take-home cancer drugs are covered by the territorial governments but sometimes with deductibles of less than $500.

- On April 19, 2012, Manitoba became the most recent province to universally fund oral cancer drugs through the new Manitoba Home Cancer Drug Program.

- Unlike the Western provinces, Ontario and the four Atlantic provinces (even New Brunswick, despite its recent drug reimbursement policy initiatives) have “limited universality” when it comes to drug coverage – oral cancer drugs are not reimbursed like IV cancer drugs which are totally covered simply because they are administered in-hospital, even if the former are first-line, life-saving treatments.

The paper quotes from an article in the Canadian Journal of Public Health, saying these differences in policy exist even though the medical needs and the patients’ preferences across provinces are the same.

Today, half of the newer cancer treatment drugs are taken at home and the burden of drug costs is shifting to the individual, a 2009 report by the Canadian Cancer Society says.

"Many of these drugs directly treat the cancer, while others are support drugs taken at home to deal with the side effects of treatment, such as nausea, pain and increased susceptibility to infection," the report says.

Value for money spent

The Cameron Institute report says an investment of roughly one per cent of Ontario's 2012 drug budget will ensure all patients in the province get the pills they need.

The report says the lack of complete public funding for the drugs in Ontario and Atlantic Canada is creating "significant financial hardship" for more than 10,000 people each year. Even a large majority of those with private insurance can end up with a 20-per-cent co-pay on the cost of treatment, which can add up to tens of thousands of dollars, it adds.

$4,000 for 2 weeks of pills

Laurelea Conrad of Toronto spoke to CBC News about what she and her husband Steve experienced after he was diagnosed last May, at age 61, with kidney cancer, which had spread to his lungs.

"My husband Steve has kidney cancer - a disease that is only treatable with an oral medication taken at home," Conrad says.

She said they discovered the "primary treatment option" — after surgery to remove a large kidney tumour — would be a chemotherapy pill called Sutent, approved for Canada in 2006.

The couple, both in business for themselves and with minimal medical insurance, had to shell out $4,000 on their credit card for two weeks' worth of medication to get the treatment started after Steve's six-week recovery from surgery.

"We were both in shock, because that's unbelievable. Fourteen pills for $4,000," or a total of $100,000 for over a year, as the "only hope for treatment of his cancer at this stage."

Conrad said they were told that because Steve was going to be taking the medication at home, they would have to pay for it. She added that kidney cancer is unresponsive to chemotherapy or radiation.

Their next step was to apply to the Trillium Drug Program, which works with hospitals in Ontario. After the "onerous" task of filling out forms and providing income statements, they learned eight weeks later that Steve qualified for support, but their deductible would still be almost $5,000 a year.

"That's an extra $400 a month on top of all the other costs of cancer — lost income, hospital parking fees, therapy, etc.," she said.

Meanwhile, before qualifying for the plan, they had to put another $4,000 on their Visa card for more medication.

Conrad said Steve's treatment has given them hope, but the added financial burden seems unfair, especially when she knows of someone living in Vancouver with cancer who pays nothing because a nurse comes to their home to administer the treatment in pill form.